04-0909_AUSTIN-FOUST ASSOCIATES, INC._Insurance CertificateCI lent#: 5091
AUSTIFOUS
A CERTIFIC OF LIABILITY
INSU NCE
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
NSR
LTR
09/09/04
PRODUCER "C
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Dealey, Renton 6: Associates
199 S Los Robles Ave Ste 540
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Pasadena, CA 91101
BKO1261229
626 844-3070
INSURERS AFFORDING COVERAGE
INSURED
Austin Foust Associates, Inc.
2020 North Tustin Avenue
Santa Ana, CA 92705
INSURER A. United States & Guaranty
-Fidelity
INSURER St. Paul Fire &Marine Ins. Co.
B:
INSURER c: XL Specialty Insurance Co.
INSURER D:
INSURER E:
FIREDAMAGE (Anymefire) 51 000,000
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
NSR
LTR
TYPE OF INSURANCE POLICY NUMBER
POLICY EFFECTIVE
DATE MM/DD/YY
POLICY —EXPIRATION
DATE MM/DD/YY
LIMITS
A
GENERAL LIABIUTY
BKO1261229
: 08/15/04
08/15/05
EACH OCCURRENCE $1 000 000
X tCOMMERCIAL GENERAL LIABILITY
FIREDAMAGE (Anymefire) 51 000,000
CLAIMS MADE a OCCUR
MEDEXP (Any ona Pa Inrso) $10,000
PERSONAL B ADV INJURY $1,000,000
GENERAL AGGflEGATE $2 QOO 000
PRODUCTS -COMP/OP AGG $2000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO- LOC
IUTOMOBILE
A
LIABILITY
ANY AUTO
BKO1261229
06/15/04
08/15105
6N 5/OS
COMJECT
BINED SINGLE LIMIT $1,000,000
(Ea accident)
ALL OWNED AUTOS
'BODILY INJURY
$_
SCHEDULED AUTOS
(Per person)
rX HIREDAUTOS
BODILY INJURY $
X NON -OWNED AUTOS
(Per accident)
PROPERTY DAMAGE $
(Per accident)
' GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
ANY AUTO
OTHER THAN EA ACC $
AUTO ONLY: AGG $
A
EXCESS LIABILITYr
BKO1261229
06/15/04
06/15/05 EACH OCCURRENCE _ $4 000 000
Xj OCCUR CLAIMS MADE
iAGGREGATE _ - $4 000 000 _
DEDUCTIBLE
RETENTION $
$
B
WORKERS COMPENSATION AND
WVA7726345
109/01/04
09/01/05 IIX WCSTATU- OTH-
T�IJMIT� ER
EMPLOYERS' LIABILITY
_,
E.L. EACH ACCIDENT _
__ _.
$1,000,000
$1,000,000
E.L. DISEASE - EA EMPLOYEE
§1,000,000
DISEASE - POLICY LIMIT
C
OTHER Professional
DPR9400354
03/25/04
03/25/05
$1,000,000 per claim
Liability
$2,000,000 annl aggr.
DESCRIPTION OF OPERATIONSILOCATIONSIVEMCLE&EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Re: Plan Check Services
City of San Juan Capistrano is additional Insured on the commercial
general liability and the hired and non -owned liability.
City of San Juan Capistrano
Attn: City Clerk's Office
32400 Paseo Adelanto
San Juan Capistrano, CA 92675
1 of 4 dlM11171A1A
DESCRIBED POLICIESBE CANCELLED BEFORE
THEREOF, THE ISSUING INSURER WILL ENDEAVOR TOMAIL30—
ETOTHE CERTIFICATE HOLDERNAMEDTOTHE LEFT, BUTFARURE
RE NOOBLIGATION OR LIABILITY OF ANY KIND UPON THE INSUREI
11MV R ACORD CORPORATION I see
Policy Number: BKO1261229
Owners Lessees or Contractors (Form B)
ADDITIbNAL INSURED
Change(s) Effective: 09/09/04
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT
CAREFULLY. This endorsement modifies insurance policy under the following:
LIABILITY COVERAGE PART:
Schedule
Name of Person or Organization:
City of San Juan Capistrano
Attn: City Clerk's Office
32400 Paseo Adelanto
San Juan Capistrano, CA 92675
SECTION II - WHO IS AN INSURED is amended to include as an insured the
person or organization shown in the Schedule, but only with respect to liability
arising out of "your work" for that insured by or for you.
Re: Plan Check Services City of San Juan Capistrano is additional
insured on the commercial general liability and the hired and
non -owned liability .
CL/BF 22 40 03 95